Look before you leap into CareB&B

At the start of this month HSJ reported on the possibility that the NHS could seek to effect a saving by discharging patients into private domestic accommodation provided by property owners with no care qualifications. There is said to be a safeguarding concern; what a surprise!

On the face of it swapping NHS hospital costs (c. £500 per day) for a bed and breakfast charge – perhaps about £100 per day – sounds attractive.

However, one must assume that discharged patients will have some care needs; otherwise, why would they wish to move into B&B and upon what basis would the NHS consider it lawful to foot the bill.

Systems and procedures

HSJ suggested that the prospect would be unregistered with the Care Quality Commission as neither the company nor the hosts would be providing care and that, in addition, the CQC could not possibly inspect so much domestic accommodation. That is misconceived. That is exactly what occurs with “care at home”, formerly domiciliary care agencies. CQC does not and cannot inspect people’s homes but do inspect systems and procedures.

The provider may escape liability by arguing transparent lack of accountable skill

Assuming that such discharged patients have some care needs – who will provide for that need, and, who will be accountable for failure, perhaps fatal. It will not be the accommodation provider. That provider may be in breach of insurance conditions and possibly in further breach of tenancy or mortgage requirements. In addition, the arrangement may risk the availability of capital gains tax allowances on property disposal. An investment attracts a charge, a principal private residence does not.

Of more importance is who will provide the care. Surely not, with any credibility on capacity, the District or Community Nursing Services or peripatetic social carers.

The NHS could commission domiciliary care or nursing services (registered by CQC) but the cost could be significant, given that there is likely to be significant 121 care required – maybe more than £500 per day. It is well known that the cost spread among a number of patients is transparently better value for money than 121 or 221 care for one or possibly two service users.

Then, there is the problem of the engagement of the accommodation provider who may have little or no skill. Does that provider simply ignore day to day dependency changes OR; what steps should they accept is necessary to take and what insurance will be in place. Will it be underwritten by enthusiastic insurers?

The provider may escape liability by arguing transparent lack of accountable skill. Where does that leave the NHS? Detailed risk assessments will be the answer, but, will that be effectively delivered when competing with an imperative to cut expenditure. The expenditure may not be saved.

The moral is: Look before you leap into a simplistically attractive short term cost saving opportunity.